Psychiatrist on postpartum psychosis defense in Lindsay Clancy murder case

[00:00:00] Speaker 1: And a trial is underway in Massachusetts for the woman accused of fatally strangling her three children. Opening statements began this morning in Plymouth for 35-year-old Lindsay Clancy, a former labor and delivery nurse at a Boston hospital. She's accused of murdering her children ages 5, 3, and 8 months old back in 2023. Clancy was partially paralyzed when she also tried to take her own life by jumping from a second floor window. Her defense attorneys claim she was suffering from postpartum psychosis at the time. Prosecutors say her actions were deliberate. Clancy's ex-husband took the stand today, talking about her state of mind days before the killings. [00:00:42] Speaker 2: Her mood seemed better. She was more active. And she was able to partake in more things. [00:00:52] Speaker 1: Now, the trial is expected to last up to two months. Lindsay Clancy could face life in prison if she is convicted. Now, this case is horrific and is hard to talk about, even think about. And it's really impossible to believe that a mother would ever harm their children. But to better help us understand postpartum psychosis, is joining me now is Dr. Julia Riddle, a reproductive psychiatrist and clinical researcher. Dr. Riddle, thank you so much for being with us. Can you explain to our viewers what postpartum psychosis is and how it's different from the baby blues or even postpartum depression? [00:01:32] Dr. Julia Riddle: Dr. Julia Riddle, yeah. Great question, Elizabeth. So, a couple comments. Postpartum psychosis is an affective disease. Now, what does that mean? Affected diseases include depression and bipolar disorder. Baby blues is not considered a disease. It is a common thing that happens now estimated in probably about 40% of women really in the week after birth. So, it's the adjustment to all the changes, the sleep changes, the exhaustion, the hormonal shifts. Looks like more tearfulness, more sentimentality. It does not look like suicidal thoughts. It doesn't look like giving up, okay? It just looks like an adjustment in mood. Postpartum depression affecting, we estimate, between 10% to 15%, right, is a depressive episode. Low mood can get to the point of suicidality. Postpartum psychosis, very, very rare, okay? It's occurring, our estimates are anywhere from two to a little over two in 1,000 births, mothers experience postpartum psychosis. Now, women that experience it, about 50% to 80% have a bipolar disorder or will go on to demonstrate that they have one. So, what is the difference here? What happens is, it can be this waxing and waning. When I say waxing and waning, it means at one moment, the woman can look completely like herself. At the next moment, she's very, very ill. It's very, very hard to diagnose, okay? It also involves delusions. Now, delusions are belief systems that when you are in them, you believe they are true. So, it could be things like the world is not safe, someone is out to get me, the government has implanted something in my body, and things like that. So, those are the differences. They really do look different. The one thing I will say at this point is that none of these are part of standard training for psychiatrists, for psychiatric NPs, or for psychiatric PAs. So, these are things that folks have to get advanced training in if they want to be able to really recognize it and diagnose it. [00:03:32] Speaker 1: I want to get a pin on that, because I want to get to that in just a moment, because there's so many things at play when a woman has a child. There's fluctuating hormones. There's sleek deprivation. And the stress of just the impact that a child has on an individual or a couple's lives. But my first question with that is, what treatments are initially available to help mothers who are experiencing some form of postpartum depression or psychosis? What does that even look like, the treatments? [00:04:02] Dr. Julia Riddle: Yeah, Elizabeth, that is exactly right. And so, the first thing is, you just hope that they're seeing someone that might screen them for these things. Because if we leave the burden on a woman, particularly in a society that normalizes so much of this, right, of course you're distressed, of course you're exhausted, of course you're feeling down. You know, isn't it tough to be a mom? It's really hard to know what's normal and what's not. But beyond that, if you're not seeing someone for your mental health, the first time you're often going to see an OB for follow-up is at six weeks, and that's the last time you see them. So, first women have to be screened. We know that about 50%, though we don't have perfect numbers on this, only about 50% even get recognized. And we know that less than half of that even receive treatment, and less than half of that receive adequate treatment. So, first and foremost, you have to be seen in a setting to really get the treatment. Now, what's available? Well, it depends on the severity. If we're seeing mild depression, for example, so if we're just talking about depression, right, therapy is a really, really effective treatment. We've done some excellent studies here at UNC. Then you get into medications, depending on the severity of the illness. So, be that SSRIs, be that the xeranilone, which is now after brexanilone, the first FDA-approved treatment for postpartum depression. These are not yet effective or that we know of for postpartum psychosis. Postpartum psychosis, in fact, needs to be recognized, one. So, again, I already talked about the training issue, but the recognition issue is just as big. You have to be trained in seeing these things to know when you're seeing it, and you have to catch a woman during the moment when she is expressing these things. Of note, and I didn't say this before, when women are experiencing postpartum psychosis, very, very often they are terrified or suspicious to tell anyone what they're thinking. So, it really requires a skill to understand what you're seeing. The treatment, the gold standard of treatment at this time is called the lithium. So, it's also a treatment for bipolar 1 disorder, and we use it in other treatments. But right now, that is our best treatment, along with getting women usually into a hospital. [00:06:09] Speaker 1: It's so overwhelming when you think about the uphill battle that so many women have to go through just to get a proper diagnosis and then get a treatment that works because it's a little bit of experimentation. You have to figure out what works and what doesn't. I'm curious. You mentioned that there's really a lack of training for so many doctors when it comes to postpartum treatment. I'm curious, though, as more information gets out there and people are being much more vocal about it, are doctors getting a better idea of why postpartum depression or psychosis? Is there research being done to help identify ways to potentially prevent it, maybe by identifying women who are more susceptible of perhaps getting it or maybe perhaps postpartum hormone therapy? Yes. [00:06:55] Speaker ?: Yes. [00:06:55] Dr. Julia Riddle: So, again, great question. So, two parts. One, I sit on the board for the National Curriculum in Reproductive Psychiatry, and we are out there training trainees, but we're also training people in the workforce. And one of the things I do is run a yearly training called the NCRP Intensive. It constantly fills because people want this information and they want to take better care of these women. Now, the research, so many people are doing this or we're trying to, right, it's often a funding issue and an access issue, but what we believe for a subset is that it is this hormonal shift that you're talking about. And it seems to be that there is a part of the brain that's implicated, the gabanergic system, which we've implicated in postpartum depression, and that is actually what led us to the development of xoranolone. And C was a major player in that development, along with the research here, in that they isolated a metabolite of progesterone, a hormone that goes way up in pregnancy and then drops off very rapidly into the postpartum. And it seems to be that there's somewhere in this cascade between these hormones and this metabolite called allopregnanolone that works on this part of the brain called the gabanergic system that seems to get dysregulated in a subset. Now, who are these women? There's also research being done out of UVA looking at biomarkers for things like postpartum depression. We're doing research here on trying to identify gene markers for postpartum depression and postpartum psychosis, but the work needs to continue to be done because how can we identify who's at risk before they get there? How can we get them into care? And these questions remain and need to continue to be answered. [00:08:32] Speaker 1: That could potentially change so many lives or maybe even save many lives. Dr. Julia Riddle, thank you so much. Great information there.